Flowers, candy and thank-you notes can be an effective way to cultivate a relationship—but do they work with nurses?
When Kathleen Turner got off a plane to visit her father in a Florida hospital, her first stop was an airport shop to buy candy for the nursing staff. In her own job, as a night-shift bedside nurse in the intensive-care unit at the University of California, San Francisco Medical Center, she knew the gesture might be appreciated.
But with her role reversal from nurse to visiting family member, Ms. Turner had a taste of what others go through when trying to navigate the relationship. “Even being savvy about how a hospital works, I felt pressure about not wanting to be a pest, and trying to figure out: How do I get my family member the kind of care I provide to my own patients?” she says.
With more families closely involved in medical care and free to visit 24/7 at many hospitals, the most important relationship—and sometimes the most intimidating one—is with the nursing staff.
Nurses, meanwhile, face pressures to communicate better with families, who often can seem pushy and demanding. In recent years, Medicare payments to hospitals have been tied in part to patient-satisfaction surveys that ask about how well nurses communicated, listened and showed courtesy and respect; ratings are posted on a public website, Hospital Compare.
“When things don’t go well between nurses and families, it’s often a breakdown in communication,” Ms. Turner says. Her advice to family members: “Even more important than candy is to ask questions when you don’t understand something, and ask how you can help with your loved one’s care.”
Ms. Turner teaches workshops to help nurses develop communication skills they often don’t learn in nursing school. She is co-author of a study, published last year in the American Journal of Critical Care, of 82 UCSF critical-care nurses who took the eight-hour workshops between March 2011 and April 2013. The percentage of nurses who reported feeling they had an excellent or very good level of skill in communicating with patients’ families was higher immediately after, and three months after, the workshop compared with before.
UCSF and the nonprofit VitalTalk, which develops communication-skills training for health-care professionals, are creating online programs based on the workshops for use by other hospitals, using a grant from the Gordon and Betty Moore Foundation.
Hospitals also are turning to patient and family-advisory councils. Last year, Jayne McCullough, an ICU nurse and co-coordinator of a UCSF patient- and family-advisory council, helped lead a public panel discussion, “Communicating with Your Doctors and Nurses to Ensure the Best Care: Lessons From Those Who Have Been There.” At the session, a former patient and another patient’s family member shared tips from their experiences.
Nurses benefit when families are active participants in care, Ms. McCullough says. Family members should never feel too intimidated to question a nurse’s actions if they suspect an error or safety risk. She cites a case where a father noticed a nurse preparing what looked like a too-large dose of an anti-seizure medication for his child and asked the nurse to check it. It was well over the correct dosage.
“You have to speak up if you think something is wrong,” Ms. McCullough says. “I would take being embarrassed or corrected any day over actually harming someone.”
Sometimes families go too far in challenging medical expertise. “When families get stressed they sometimes go outside their role. They want to determine care or start trying to dictate things,” says Karen M. Anderson, a clinical nurse specialist in patient- and family-centered care at the Hospital of the University of Pennsylvania, in Philadelphia.
They may ask a nurse to increase a patient’s pain medication above the prescribed dose, for example. “You have to trust the doctor had reasons, or the nurse knows when to increase the dose,” she says.
Nurses welcome guidance on patients’ goals and preferences, which can help make the job of care easier. “A nurse is an expert in vital signs and seeing nuances and subtle changes in the patient’s condition,” Ms. Anderson says. “But you are the expert in your mom.”
“Your mom needs you to say to the nurse, ‘You’re asking her to take that pill, but I can tell you she does a lot better if you put it in her yogurt,’ ” Ms. Anderson says.
Anita McGinn-Natali, an artist in Media, Pa., joined an advisory council in 2012 at the Hospital of the University of Pennsylvania, where her husband, Clark, has undergone 15 surgeries related to an oral cancer diagnosed in 2007. Nurses taught her how to care for her husband at home between procedures; he was often assigned to the same nurses, who got to know him and his preferences and needs.
The familiarity made it easier for her to build relationships. One time, she came in late and found her husband’s room was a mess. He needed a clean gown, and he felt ignored.
She didn’t know the nurses on duty, and figured there might have been a problem with cleaning crews or an extra-hectic day. Rather than confront the nurses, she quietly went to the nurse manager and expressed her concerns, which were quickly resolved.
“I don’t ever want to be the screaming, nagging patient’s loved one who wants something done right now,” Ms. McGinn-Natali says. “But you can approach someone in a noncombative way to discuss the issue without pointing the finger or making a scapegoat out of anyone.”
She says her talk with the nurse manager helped the staff recognize “from the patient and family view that this looks like a dirty room and a patient who hasn’t been tended.”
At the Hospital of the University of Pennsylvania, gifts like flowers or candy are seen as “appreciation for the care received, not as bribes in the hopes of getting special treatment,” Ms. McGinn-Natali says. She writes letters to managers to praise the care her husband received from nurses. Nurses, in turn, have thanked her for the letters, which go in their personnel files.
Diane Schweitzer, who works on nursing programs as a consultant to the Gordon and Betty Moore Foundation, says she has an inside perspective “on how hard front-line nurses work.” When her 88-year-old mother was hospitalized last year for a knee replacement, Ms. Schweitzer says, the pain medications made her a little confused and she could be persnickety, for example if she rang the call bell for coffee and thought the nurse didn’t respond quickly.
Ms. Schweitzer and her sister took turns visiting every day, and started bringing brownies, cookies or fresh fruit for the staff. In addition to thanking the nurses, she says, “there was a little bit of bribery in there.”
While the sisters acted as their mother’s advocate, they also helped her understand the pressures nurses face. “If the choice is between someone who needs coffee and someone having a medication reaction, the priorities are clear,” Ms. Schweitzer says. “It’s not a hotel.”